The role of universities and NGOs in a new research and development system

Chris Redd is a 3rd year medical student at Peninsula Medical School in the UK. He has been on the Executive Board of Universities Allied for Essential Medicines (UAEM) Europe since April, 2013, and is now in his second term.

On May 14, 2014, a British Parliamentary Committee on Science and Technology wrote to the minister in charge of science and universities, David Willetts, to warn against Pfizer’s mooted takeover of AstraZeneca. The $69 billion bid stirred controversy in the UK, because it was seen as a threat to British science and the public interest. These discussions approached the fundamental problems of our research and development (R&D) system, exposing serious concerns about all aspects of the pharmaceutical business model. More recently, Ebola and antibiotic resistance have kept our attention on the pitfalls of commercially driven drug development. Coupling that with soaring prices on new drugs for cancer and hepatitis C, one sees a growing consensus across all sectors on the need to change. An international coalition of patients, clinicians, students, civil society, and politicians is beginning to face up to a system that is desperately close to breaking.

The words of Paul Hunt, former UN Special Rapporteur on the right to the highest attainable standard of health, seem finally to be striking home. Pharmaceutical companies exist to fulfil a function in society, Hunt said in 2009, and so “they must demonstrably do everything possible… to fulfil their social function and human rights responsibilities.”Following this logic, a system which does not honour human rights is dysfunctional and is one we need to change.

Current attitudes are summed up in a recent report from the UN Conference on Trade and Development, which concludes that the R&D system is simply falling apart, even citing pharma executives in its analysis. On the global scene, progress has been made too. The WHO has finally begun to implement the suggestions of the Consultative Expert Working Group. At the 67th World Health Assembly, the four demonstration projects, albeit less-innovative ones, were approved, and a resolution was adopted for the establishment of a pooled funding mechanism.

The non-profit sector has already begun to move into this space, with DNDi exemplifying a burgeoning non-profit sector in drug development. Other notable examples include Bioventures for Global Health, and the Medicines for Malaria Venture. The public-private partnership (PPP) model has been shown to be effective - if only because there is no other way to access the vast drug libraries of pharmaceutical companies. Even within the PPP model, reflecting a broader theme, commercialisation is seen as a tiny motivating factor. Some of the most promising cases of drug development are the open source initiatives, which abandon the traditional paradigm of patent monopolies in search of a more collaborative approach.

At the same time, a competing dialogue has been developing. ‘Encouraging a British Invention Revolution’ by Sir Andrew Witty, CEO of GlaxoSmithKline and Chancellor of the University of Nottingham, was published this summer. The report, commissioned by the UK government, calls for universities to serve a third function in addition to education and research: to facilitate economic growth as a core strategic goal.

Witty’s report represents a secondary discussion on new R&D, and one which must be given due attention. While to some they may seem innocent and well-meaning, arguments like this are behind legislation such as the Bayh-Dole Act in the US, which has driven universities to patent their research. Making university research funding dependent upon the economic growth it produces is tantamount to tying the research agenda to profit. Under the watches of pseudo-democratic organisations such as the World Trade Organization, this model is exported the world over, often in exchange for supposedly favourable trade agreements.

Universities, as centres of public science, must not be co-opted by commercial interests under the guise of economic growth. The Manchester Manifesto emphasises the reciprocal relationship between science and society, working together to further public understanding and promote mutual benefit. Universities have a social function, which is demonstrably not to make money. The steps they can take to honour human rights, for example, stretch far and wide.

And yet universities themselves have been sluggish to respond. In the UK, six universities have spoken publicly about the need to balance commercial interests with ethical ones, starting with Edinburgh in 2009, and most recently including the University of Exeter this August.

These statements, however, were the result of student activism rather than episodes of altruism. Furthermore, it seems absurd that universities don’t already consider the ethical aspects to their decisions. Finally, these commitments are often vague and non-binding, lacking in concrete steps and processes of reporting or evaluation. Unfortunately, universities in the rest of the world are not doing much better. At the moment, the most comprehensive data on the subject show that, by and large, (US) universities are falling short.

There are signs, at least in the licensing of health technology patents, that things are beginning to change. In July, a report by the UK All Party Parliamentary Group on Tuberculosis called for socially responsible licensing to be implemented across all UK research funding. On the international level, India and others have spoken in the World Trade Organization at length to try to reframe the way universities are perceived in R&D.

One of the best examples of the importance of the public versus private science debate is the Human Genome Project. It may seem absurd, but Sir John Sulston and colleagues were actually forced into a race to keep the Human Genome in the public domain. Fortunately, they succeeded in safeguarding this knowledge for society, and taught us a lesson we must not forget.

In the first Access 2 Medicines week (Nov 1-7, 2014), members of Universities Allied for Essential Medicines attempted to bring this debate to the public by providing a platform for all parties to add their voice to the discussion. With their petition, they hope to convince universities that, as hubs of innovation, universities have the potential and responsibility to deliver great advances in global health, and that they can lead the way in establishing a new, open R&D paradigm based on collaboration.

Announcement

As our journal continues to grow, we have had to reconsider the direction of the blog.
No new content is currently being published on The Lancet Global health blog.
The blog will close on 31st December 2018, at which point all published content will be archived and made available on request.
We will continue to publish leading commentary and analysis in our journal.
To find out more, including how to submit,
please see: https://www.thelancet.com/langlo/about

The Lancet Global Health Journal

To read original research articles on The Lancet Global Health journal website
click here.